Oral Surgery · patient case question
What is the most common site for medication-related osteonecrosis of the jaw?
Patient case: Extraction, infection and a difficult healing
demo: 44-year-old female
chief: Severe throbbing pain and a foul taste four days after an extraction, plus swelling from a separate upper tooth.
history: Osteoporosis treated with intravenous zoledronic acid for three years. She smokes. She had corrective surgery for tetralogy of Fallot in childhood with no residual defect.
meds: Zoledronic acid, calcium and vitamin D.
findings: The socket at site 32 is empty of clot with exposed bone and exquisite tenderness. There is no purulence. Separately, tooth 4 is grossly carious with vestibular swelling and tenderness.
Show answer and explanation
Correct answer: B. The posterior mandible
- A. The maxilla overall accounts for a minority of cases, roughly a quarter.
- B. Correct. The posterior mandible accounts for the majority of cases, roughly two thirds. Its dense cortical bone and relatively poorer blood supply compared with the maxilla make it vulnerable, and mylohyoid ridge and lingual torus areas with thin overlying mucosa are frequent starting points.
- C. The anterior maxilla is an uncommon site.
- D. The condyle is not a typical site; lesions arise in tooth-bearing and alveolar regions where mucosal breach occurs.